The Resolution of Photophobia and Short-Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing (SUNCT) Subsequent to Growth Hormone Adenoma Resection: Elucidating the Proposed Pathophysiological Mechanisms.

Abstract

SUNCT is a rare and disabling type of headache. Here, we present a patient with pituitary adenoma and 2-years history of chronic SUNCT accompanied by unusual, disabling photophobia. Past medical records revealed acromegaly and pituitary adenoma resection in 2009, with recurrence in 2015, further invading the ipsilateral cavernous sinus and dura mater. Pharmacotherapy and multiple cranial peripheral nerve blocks were partially effective. After endoscopic endonasal trans-sphenoidal tumor resection, attacks ceased completely. Our findings suggest that dural invasion of the pituitary adenoma in the left cavernous sinus was the primary cause of the ipsilateral SUNHA, as evidenced by the cessation of symptoms following complete tumor resection. We advocate investigating and treating secondary causes in SUNCT patients. The presence of photophobia in various types of headaches suggests a crosstalk between visual and pain pathways. The proposed pathophysiology of photophobia and headache due to pituitary adenoma is discussed.